Provider Demographics
NPI:1891937165
Name:EZ SUPER PHARMACY INC.
Entity Type:Organization
Organization Name:EZ SUPER PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAJID
Authorized Official - Suffix:
Authorized Official - Credentials:PRES
Authorized Official - Phone:718-992-1204
Mailing Address - Street 1:37-16 3RD AVE.
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456
Mailing Address - Country:US
Mailing Address - Phone:718-992-1204
Mailing Address - Fax:718-992-2501
Practice Address - Street 1:3716 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2103
Practice Address - Country:US
Practice Address - Phone:718-992-1204
Practice Address - Fax:718-992-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029343302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization